Provider Demographics
NPI:1891004743
Name:EBENEZER WELLCARE, INC
Entity Type:Organization
Organization Name:EBENEZER WELLCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORIAKHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-471-1211
Mailing Address - Street 1:6610 HARWIN DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2232
Mailing Address - Country:US
Mailing Address - Phone:713-471-1211
Mailing Address - Fax:713-660-0077
Practice Address - Street 1:6610 HARWIN DR
Practice Address - Street 2:SUITE 212
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2232
Practice Address - Country:US
Practice Address - Phone:713-471-1211
Practice Address - Fax:713-660-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health